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The aim of this study was to systematically investigate existing literature on the costs of home-based telemedicine programs, and to further summarize how the costs of these telemedicine programs vary by equipment and services provided. We undertook a systematic review of related literature by searching electronic bibliographic databases and identifying studies published from January 1, 2000, to November 30, 2017. The search was restricted to studies published in English, results from adult patients, and evaluation of home telemedicine programs implemented in the United States. Summarized telemedicine costs per unit of outcome measures were reported. Twelve studies were eligible for our review. The overall annual cost of providing home-based telemedicine varied substantially depending on specific chronic conditions, ranging from USD1,352 for heart failure to USD206,718 for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and diabetes as a whole. The estimated cost per-patient-visit ranged from USD24 for cancer to USD39 for CHF, COPD, or chronic wound care. The costs of home-based telemedicine programs varied substantially by program components, disease type, equipment used, and services provided. All the selected studies indicated that home telemedicine programs reduced care costs, although detailed cost data were either incomplete or not presented in detail. A comprehensive analysis of the cost of home-based telemedicine programs and their determinants is still required before the cost efficiency of these programs can be better understood, which becomes crucial for these programs to be more widely adopted and reimbursed.

Timely intervention for people with alcohol dependence in primary care is needed. Primary care services have a key role in supporting adults with alcohol dependence and require appropriate provision of services. To examine the perceptions of both primary care practitioners and adults with alcohol dependence regarding service provision and to describe help seeking behaviours for adults with alcohol dependence. Qualitative study consisting of semi-structured interviews with adults with alcohol dependence, healthcare professionals and staff members of specialist alcohol services who had previous or current experience in the management, treatment, or referral of adults with alcohol dependence in Northwest England. Interviews were conducted with ten adults with alcohol dependence and 15 staff. Data were analysed thematically, applying principles of constant comparison. Three themes were identified following inductive thematic analysis. The first theme, point of access relates to current service provision being reactive rather than preventative, the stigma associated with alcohol dependence and a person's preparedness to change. The second theme identified was treatment process and pathways that highlights difficulties of engagement, mental health support, direct access and person-centred support. The third theme was follow-up care and discusses the opportunities and threats of transitional support or aftercare for alcohol dependence, signposting and peer support. There are clear opportunities to support adults with alcohol dependence in primary care and the need to increase provision for timely intervention for alcohol related issues in primary care.

Suicide is the leading cause of death of children and young people under 35 in the UK, and suicide rates are rising in this age group. Schools are considered an appropriate and logical setting for youth suicide prevention activities, with universal, selective, and indicated approaches all demonstrating efficacy. Given that international best practice recommends suicide prevention programmes combine these approaches, and that to date this has not been done in school settings in the UK, this study aims to evaluate the feasibility of delivering a suicide prevention programme incorporating universal, selective, and indicated components in UK schools. This study is a feasibility cluster-randomised controlled trial (RCT) of an adapted version of the Multimodal Approach to Preventing Suicide in Schools (MAPSS) programme. The programme, initially developed in Australia, involves delivering universal psychoeducation to all pupils, screening them for suicide risk, and delivering Internet-based Cognitive Behavioural Therapy (Reframe IT-UK) to those students identified as being at high-risk for suicide. The programme will be trialled in six secondary schools in Northwest England and will target Year 10 students (14- and 15-year-olds). The primary aims are to assess: 1) the acceptability and safety of delivering MAPSS in a school setting in the UK; 2) the social validity of the MAPSS programme; and 3) the feasibility of delivering a large-scale, appropriately powered, cluster-RCT and economic evaluation of this intervention in the future. Secondary aims are to assess changes over time in mental health and wellbeing outcomes. This study is the first to evaluate a suicide prevention programme comprising universal, selective, and indicated components in UK schools. If the programme is found to be feasible, it could be more widely tested in schools and may ultimately lead to reduced rates of suicide and suicidal behaviour in young people.

Past research has indicated that individuals with Ehlers-Danlos Syndromes (EDS) and Generalized Hypermobililty Spectrum Disorder (G-HSD) report psychological and psychiatric symptoms, particularly anxiety disorders and depressive symptoms, at much greater rates than the general population. However, these studies have been primarily conducted in small samples at European centres. We report a retrospective chart review from 1035 consecutive patients (88% female) assessed for EDS/G-HSD at the GoodHope EDS Clinic at Toronto General Hospital between June 2019 and June 2021. Prior to assessment, all patients completed self-reported mental health screening questions, the Inventory of Depressive and Anxiety Symptoms – Dysphoria scale, and the Borderline Symptom List-23. The majority of patients reported current or past anxiety or depressive symptoms (53–87%), and a substantial minority reported significant mental health concerns, including Posttraumatic Stress Disorder (4.7–34.8%), disordered eating (19%), self-harm (3-29.2%), and suicidal behaviour (7.8–18.6%). Patients did not differ by diagnostic category on self-report measures of dysphoria or borderline symptoms. Individuals with G-HSD reported higher rates of anxiety and depression in clinical interview than those diagnosed with non-hypermobile EDS, and endorsed a higher rate of having “struggled with anxiety or depression” on the mental health screening questionnaire than individuals not diagnosed with EDS/G-HSD. No other differences emerged across diagnostic groups. These findings highlight the need for psychological support for individuals with EDS or G-HSD.

Oncology Nursing Practice At Brigham and Women's Hospital the newly licensed nurse (NLN) receives a 12-week orientation in the oncology service. To prepare for independent practice, orientees are matched with a preceptor for 10 weeks of dayshift and 2 weeks of night shift. Over the past few years, there has been an increased turnover of bedside nurses. The 2020 turnover rate for RNs increased by 2.8%. When filtered to NLNs within their first year of practice the 2020 turnover rate was 23.9% (Aull & Nobles, 2022). Units continue to regularly orient multiple NLNs, with the majority assigned to night shifts. The night shift workflow promotes development of crucial skills like time management and organization. The ability to orient with less interruptions can help NLNs build confidence in their nursing abilities. However, they must also navigate challenges, including disrupted sleep patterns, limited access to resources, and less experienced staff. Night shift NLNs need to adjust to a different routine and cluster care. Ongoing dialogue between preceptor and orientee is important to ensure a robust orientation. The preceptor will continue to evaluate the NLN's skill set and the bidirectional discussion can help build confidence and independence, as the NLN progresses towards independent practice.It is beneficial to personalize each orientation experience while still ensuring consistency in education. Everyone has a different learning style and receives information differently; this is something a preceptor can observe and discuss with the orientee. A concept to always reinforce is the ability to obtain information, assistance, and support from your institution and coworkers. There is often limited experience available on night shift, so it is not enough to rely on the charge nurse or coworkers to know the answer to everything. After completing the didactic education component, it is essential to have nurses practice their skills hands on. The concept of experiential learning engages nurses in experiences that allow them to practice and apply new knowledge while also receiving feedback in a controlled supportive environment (Ward, 2022). Sometimes there is fear of asking too many questions and feeling like a burden to other nurses, doctors, as well as support staff. Throughout orientation these nurses should feel supported and encouraged to feel confident in their assessments, successfully obtain information and ask questions as needed to not only help themselves but to better serve their patients.

Stable nitrogen isotope (δ15N) data from sediment cores taken in clear-water Upper Russian Lake (Kenai River Watershed, Alaska, USA) indicate that sockeye salmon (Oncorhynchus nerka) populations varied significantly over the past 4000 years, with a prominent ~ 650-year period of lower salmon abundance from ~ 100 BCE to 550 CE. Sediment characteristics during this ~ 650-year interval reflect glacial sediment input, which may have contributed to the salmon decline by degrading spawning habitat and reducing carrying capacity. The decline, however, coincides with large reductions in sockeye salmon abundance identified previously in Karluk and Akalura lakes on Kodiak Island, > 400 km southwest, supporting the possibility of regionally synchronous, multi-centennial production regimes that may originate from shifts in oceanographic conditions such as biological productivity in the northeastern Pacific Ocean. Under such a scenario, coincidence with watershed glacial activity indicates a common driver, i.e. regional climate change. Climate conditions that led to significant glacial advances in this part of the Kenai Peninsula (cold and/or wet conditions) may have also created unfavorable ocean conditions during critical periods in the marine phase for these stocks of Gulf of Alaska sockeye salmon. Future climate projections and management strategies should focus on how climate regimes impact not only prey availability for salmon at sea, but also local conditions for spawners and juveniles.

Our objective was to assess the relationship between hyperbilirubinemia with and without kernicterus and metabolic profile at newborn screening. Included were 1,693,658 infants divided into a training or testing subset in a ratio of 3:1. Forty‐two metabolites were analyzed using logistic regression (odds ratios (ORs), area under the receiver operating characteristic curve (AUC), 95% confidence intervals (CIs)). Several metabolite patterns remained consistent across gestational age groups for hyperbilirubinemia without kernicterus. Thyroid stimulating hormone (TSH) and C‐18:2 were decreased, whereas tyrosine and C‐3 were increased in infants across groupings. Increased C‐3 was also observed for kernicterus (OR: 3.17; 95% CI: 1.18–8.53). Thirty‐one metabolites were associated with hyperbilirubinemia without kernicterus in the training set. Phenylalanine (OR: 1.91; 95% CI: 1.85–1.97), ornithine (OR: 0.76; 95% 0.74–0.77), and isoleucine + leucine (OR: 0.63; 95% CI: 0.61–0.65) were the most strongly associated. This study showed that newborn metabolic function is associated with hyperbilirubinemia with and without kernicterus.

BackgroundPopular support for access to abortion and contraceptive services is often based on the idea that they will help women determine the trajectory of their life course. This study examined whether receiving versus being denied an abortion affects aspirational life goal setting and attainment 5 years later.MethodsWe compared women who sought and were denied an abortion because they were 3 weeks beyond the gestational limit (‘Parenting-Turnaways’) to those who received an abortion in the first trimester (‘First-Trimesters’); received an abortion within 2 weeks of the facility’s gestational limit (‘Near-Limits’); and sought an abortion, were turned away and received an abortion elsewhere or placed their baby for adoption (‘Non-Parenting-Turnaways’). We used mixed effects logistic regression analyses to estimate the odds of setting an aspirational plan and to estimate the odds of both setting and achieving an aspirational 5-year plan.ResultsAt 1 week post abortion-seeking, 791 women reported 1864 5-year plans, most of which were aspirational (n=1692, 91%). Parenting-Turnaways had lower odds of setting an aspirational 5-year plan than Near-Limits (OR 0.36, 95% CI 0.18 to 0.73). There were no differences by group in achieving aspirational 5-year plans among those who had them.ConclusionsSoon after abortion-seeking, women denied a wanted abortion were less optimistic about their long-term futures than women who received a wanted abortion. Abortion access can help women set positive long-term goals.

Objective: Crisis lines are the first mental health service contact point for many people, making them a vital community and public health intervention. Given the current and potential utility of crisis lines, better understanding the characteristics, socioeconomic factors and subsequent referral pathways of callers is critical to identifying targeted ways to improve such services. Study Design: The dataset captured calls to the Cheshire & Wirral Partnership NHS Foundation Trust (CWP) crisis line between August 2020 and August 2021. Calls were examined if self-harm, risk to self, or overdose were reported by the caller. Descriptive analyses were conducted to produce a clinical and demographic profile of the callers using the crisis line. Results: Call handlers were significantly more likely to call 999, hand over to a practitioner and less likely to provide advice and guidance if self-harm, risk to self or overdose was reported. Social issues were found to be significantly associated with all 3 outcomes: self-harm, risk to self and overdose. Conclusion: The current study provides the first exploratory analysis of the socioeconomic factors and resultant care pathways for those contacting a UK crisis line service. The findings have important implications for community early intervention efforts to reduce self-harm and suicidal behaviours.